Rates of Homicide, Suicide, and Firearm-Related Death Among
Children -- 26 Industrialized Countries

During 1950-1993, the overall annual death rate for U.S.
children aged less than 15 years declined substantially (1),
primarily reflecting decreases in deaths associated with
unintentional injuries, pneumonia, influenza, cancer, and
congenital anomalies. However, during the same period, childhood
homicide rates tripled, and suicide rates quadrupled (2). In 1994,
among children aged 1-4 years, homicide was the fourth leading
cause of death; among children aged 5-14 years, homicide was the
third leading cause of death, and suicide was the sixth (3). To
compare patterns and the impact of violent deaths among children in
the United States and other industrialized countries, CDC analyzed
data on childhood homicide, suicide, and firearm-related death in
the United States and 25 other industrialized countries for the
most recent year for which data were available in each country (4).
This report presents the findings of this analysis, which indicate
that the United States has the highest rates of childhood homicide,
suicide, and firearm-related death among industrialized countries.

In the 1994 World Development Report (5), 208 nations were
classified by gross national product; from that list, the United
States and all 26 of the other countries in the high-income group
and with populations of greater than or equal to 1 million were
selected because of their economic comparability and the likelihood
that those countries maintained vital records most accurately. In
January and February 1996, the ministry of health or the national
statistics institute in each of the 26 countries were asked to
provide denominator data and counts by sex and by 5-year age groups
for the most recent year data were available for the number of
suicides (International Classification of Diseases, Ninth Revision
{ICD-9}, codes E950.0-E959), homicides (E960.0-E969), suicides by
firearm (E955.0-E955.4), homicides by firearm (E965.0-E965.4),
unintentional deaths caused by firearm (E922.0-E922.9), and
firearm-related deaths for which intention was undetermined
(E985.0-E985.4); 26 (96%) countries, including the United States,
provided complete data *. Twenty (77%) countries provided data for
1993 or 1994; the remaining countries provided data for 1990, 1991,
1992, or 1995. Cause-specific rates per 100,000 population were
calculated for three groups (children aged 0-4 years, 5-14 years,
and 0-14 years). The rates for homicide and suicide by means other
than firearms were calculated by subtracting the firearm-related
homicide and firearm-related suicide rates from the overall
homicide and suicide rates. Rates for the United States were
compared with rates based on pooled data for the other 25
countries. Of the 161 million children aged less than 15 years
during the 1 year for which data were provided, 57 million (35%)
were in the United States and 104 million (65%) were in the other
25 countries.

Overall, the data provided by the 26 countries included a
total of 2872 deaths among children aged less than 15 years for a
period of 1 year. Homicides accounted for 1995 deaths, including
1177 (59%) in boys and 818 (41%) in girls. Of the homicides, 1464
(73%) occurred among U.S. children. The homicide rate for children
in the United States was five times higher than that for children
in the other 25 countries combined (2.57 per 100,000 compared with
0.51) (Table_1).

Suicide accounted for the deaths of 599 children, including
431 (72%) in boys and 168 (28%) in girls. Of the suicides, 321
(54%) occurred among U.S. children. The suicide rate for children
in the United States was two times higher than that in the other 25
countries combined (0.55 compared with 0.27) (Table_1). No
suicides
were reported among children aged less than 5 years.

A firearm was reported to have been involved in the deaths of
1107 children; 957 (86%) of those occurred in the United States. Of
all firearm-related deaths, 55% were reported as homicides; 20%, as
suicides; 22%, as unintentional; and 3%, as intention undetermined.
The overall firearm-related death rate among U.S. children aged
less than 15 years was nearly 12 times higher than among children
in the other 25 countries combined (1.66 compared with 0.14)
(Table_1). The firearm-related homicide rate in the United
States
was nearly 16 times higher than that in all of the other countries
combined (0.94 compared with 0.06); the firearm-related suicide
rate was nearly 11 times higher (0.32 compared with 0.03); and the
unintentional firearm-related death rate was nine times higher
(0.36 compared with 0.04). For all countries, males accounted for
most of the firearm-related homicides (67%), firearm-related
suicides (77%), and unintentional firearm-related deaths (89%). The
nonfirearm-related homicide rate in the United States was nearly
four times the rate in all of the other countries (1.63 compared
with 0.45), and nonfirearm-related suicide rates were similar in
the United States and in all of the other countries combined (0.23
compared with 0.24).

The rate for firearm-related deaths among children in the
United States (1.66) was 2.7-fold greater than that in the country
with the next highest rate (Finland, 0.62) (Figure_1). Except
for
rates for firearm-related suicide in Northern Ireland and
firearm-related fatalities of unknown intent in Austria, Belgium,
and Israel, rates for all types of firearm-related deaths were
higher in the United States than in the other countries. However,
among all other countries, the impact of firearm-related deaths
varied substantially. For example, five countries, including three
of the four countries in Asia, reported no firearm-related deaths
among children. In comparison, firearms were the primary cause of
homicide in Finland, Israel, Australia, Italy, Germany, and England
and Wales. Five countries (Denmark, Ireland, New Zealand, Scotland,
and Taiwan) reported only unintentional firearm-related deaths.

Editorial Note

Editorial Note: The findings in this report document a high rate of
death among U.S. children associated with violence and
unintentional firearm-related injuries, particularly in comparison
with other industrialized countries. Even though rates in all other
countries were lower than those in the United States, rates among
other countries varied substantially and were particularly low in
some countries. Although specific reasons for the differences in
rates among countries are unknown, previous studies have reported
on the associations between rates of violent childhood death and
low funding for social programs (6), economic stress related to
participation of women in the labor force (7,8), divorce,
ethnic-linguistic heterogeneity, and social acceptability of
violence (9).

The findings of the analysis in this report are subject to at
least three limitations. First, although the data were obtained
from official sources and were based on ICD-9 codes, the
sensitivity and specificity of the vital records and reporting
systems may have varied by country. Second, because 21 (81%)
countries each reported less than 10 firearm-related deaths among
children aged 0-14 years, the firearm-related death rates for those
countries, when not pooled, are unstable and may vary substantially
for different years. Finally, only one half of the countries
(including the United States) reported all four digits of the ICD-9
codes for firearm-related deaths; the fourth digit distinguishes
whether deaths were caused by injuries from firearms or by other
explosives. For countries in which this distinction could not be
made, the firearm-related death rates may be overestimated
slightly.

In May 1996, the 49th World Health Assembly adopted a
resolution that declared violence a leading worldwide public health
problem and urged all member states to assess the problem of
violence and to communicate their findings to the World Health
Organization (10). Cross-cultural comparisons may identify key
factors (e.g., attitudinal, behavioral, educational, socioeconomic,
or regulatory) not evident from intranational studies that could
assist in the development of new country-specific strategies for
preventing such deaths.

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